TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Behavior Therapy
KW - Combined Modality Therapy
KW - Counseling
KW - Crisis Intervention
KW - Global Health
KW - Health Status Disparities
KW - Humans
KW - Narcotic Antagonists/therapeutic use
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/diagnosis/drug therapy/epidemiology/therapy
KW - Primary Health Care/methods
KW - Psychiatric Rehabilitation/methods
KW - Treatment Outcome
KW - United States/epidemiology
AU - M. Buresh
AU - R. Stern
AU - D. Rastegar
A1 - 
AB - Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
AD - Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA mburesh2@jhmi.edu.; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.; Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.; Department of Addiction Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BT - BMJ (Clinical research ed.)
C5 - Education & Workforce; Opioids & Substance Use
CY - England
DO - 10.1136/bmj.n784
JF - BMJ (Clinical research ed.)
LA - eng
M1 - Journal Article
N2 - Opioid use disorder (OUD) is a common, treatable chronic disease that can be effectively managed in primary care settings. Untreated OUD is associated with considerable morbidity and mortality-notably, overdose, infectious complications of injecting drug use, and profoundly diminished quality of life. Withdrawal management and medication tapers are ineffective and are associated with increased rates of relapse and death. Pharmacotherapy is the evidence based mainstay of OUD treatment, and many studies support its integration into primary care settings. Evidence is strongest for the opioid agonists buprenorphine and methadone, which randomized controlled trials have shown to decrease illicit opioid use and mortality. Discontinuation of opioid agonist therapy is associated with increased rates of relapse and mortality. Less evidence is available for the opioid antagonist extended release naltrexone, with a meta-analysis of randomized controlled trials showing decreased illicit opioid use but no effect on mortality. Treating OUD in primary care settings is cost effective, improves outcomes for both OUD and other medical comorbidities, and is highly acceptable to patients. Evidence on whether behavioral interventions improve outcomes for patients receiving pharmacotherapy is mixed, with guidelines promoting voluntary engagement in psychosocial supports, including counseling. Further work is needed to promote the integration of OUD treatment into primary care and to overcome regulatory barriers to integrating methadone into primary care treatment in the US.
PP - England
PY - 2021
SN - 1756-1833; 0959-8138
T1 - Treatment of opioid use disorder in primary care
T2 - BMJ (Clinical research ed.)
TI - Treatment of opioid use disorder in primary care
U1 - Education & Workforce; Opioids & Substance Use
U2 - 34011512
U3 - 10.1136/bmj.n784
VL - 373
VO - 1756-1833; 0959-8138
Y1 - 2021
Y2 - May 19
ER -